Alteration of morphologic and mechanical properties of trabecular bone in the osteoarthritic proximal tibia may be a contributing factor in tibial component loosening. To explore this issue, the authors performed tissue property measurements, morphologic analysis, and mechanical testing of subchondral, epiphyseal, and metaphyseal trabecular bone specimens retrieved from six human proximal tibias exhibiting a range of medial unicondylar osteoarthritic degeneration. Apparent density in the proximal tibia was altered according to varus misalignment and medial subluxation associated with medial osteoarthritis of the knee. In subchondral bone, a decrease in tissue mineralization contributed to a significant reduction in axial mechanical properties with degenerative disease (P < .0005). In epiphyseal and metaphyseal bone, trabecular thickness and the number of trabeculae increased linearly with volume fraction, providing a power law relationship between axial elastic modulus and apparent density (R² = .84). Average elastic properties of the tibial epiphysis and metaphysis were not reduced by degenerative disease (P < .05). The results suggest that absolute minimization of tibial resection might not be an optimal strategy for tibial component fixation and that mechanical properties of the tibial resection surface are more homogeneous in planes parallel to the joint surface than in a plane normal to the longitudinal axis of the tibia.
Keywords: mechanical testing; osteoarthritis; proximal tibia; stereology; total knee arthroplasty; trabecular bone